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Placebos rather than plans

SLOVAKIA'S health-care system has serious problems and one need not be a neurosurgeon to understand that. Many treatments have been prescribed, ranging from expensive infusions, through placebos, to attempts at amputation. The system has been attended to by shamans who promised miracles and also by ‘government doctors’ who focused on symptoms but never root causes, backed by a slew of bureaucrats mostly interested in conserving the model of a bottomless health-care well that the state must continuously fill with cash.

SLOVAKIA'S health-care system has serious problems and one need not be a neurosurgeon to understand that. Many treatments have been prescribed, ranging from expensive infusions, through placebos, to attempts at amputation. The system has been attended to by shamans who promised miracles and also by ‘government doctors’ who focused on symptoms but never root causes, backed by a slew of bureaucrats mostly interested in conserving the model of a bottomless health-care well that the state must continuously fill with cash.

But the turmoil now consuming Slovakia’s health-care sector after about 1,200 doctors left their practices in state-run hospitals on December 1, after refusing to withdraw resignation notices submitted at the end of September in protest against conditions in the sector, will hardly bring health to the suffering patient. Several of the country’s hospitals are now operating in an emergency regime and Slovaks in need of medical care have become hostages to the mass protest poorly managed by the doctors’ trade union, LOZ, and the Health Ministry as well.

One does not need to be a skilled union negotiator to understand that without good timing and knowing when to find a reasonable compromise, strikes and protests, especially in sensitive areas like health care, will eventually undercut even the best causes by turning innocent citizens into unwitting hostages.

The government has either fulfilled, or pledged to fulfill, all the key demands of the protesting doctors except their salary demands. The state even agreed to the demand – thought to be most problematic in the initial stages of the protest – to halt the transformation of state-run facilities into joint stock companies. The doctors also got a promise that hospitals would respect the provisions of the Labour Code, that payments by health insurers in the future will reflect the actual costs of health-care providers, and that all the doctors who withdrew resignation notices would get their jobs back.

Most workplace disputes rarely boast such a rich harvest – but then rarely does any kind of work stoppage get this close to the bones of each and every citizen. To spice up the action, the head of the doctors’ union, Marián Kollár, is now calling for the dismissal of Health Minister Ivan Uhliarik, who obviously does not belong in any hall of fame of government ministers. But it is just as doubtful that his recall now, as the election campaign is raging across Slovakia, will contribute to the well-being of Slovak doctors. And besides, Uhliarik has offered to resign if that would calm the waters.

By December 1 it seemed that only the unresolved issue of doctors’ salaries was why patients were having their surgeries rescheduled and future mothers were waiting nervously to see where they might have to give birth to their babies. The government had offered the doctors a €300 monthly salary increase in late November even while employees in other sectors face salary freezes and layoffs in these tough economic times.

Can €300 heal the feelings of frustration and anger that have been building in many physicians over the past two decades or so due to state neglect of their hospitals? No, it really cannot. But the higher salaries demanded by the doctors will not treat the main ills of the country’s health-care system either – the issue that the doctors had originally defined as their primary cause. What the state has now offered is for doctors’ salaries to be pegged at 1.05 to 1.6 times the national average salary beginning in January 2012, with an increase to 1.17 to 1.73 times the average salary in April 2012, depending on a doctor’s education and experience.

The principal problem of Slovakia’s health-care sector is not that insufficient money has been poured into the system but that the available funds have been ineffectively spent and managed. Perhaps it will be interesting for all those citizens awaiting medical care to watch for any kind of improvement brought to this fundamental problem by the protest.

An online poll by the Sme daily found that 77 percent of the 5,189 who participated thought it was the fault of the doctors’ union that an agreement was not reached by December 1. Another poll in which 63,562 people answered the online question of whether they supported the physicians resulted in 77 percent saying “no”. Online polls have their problems but they do give some sense of the public’s reaction.

Parliamentary elections are nearing and the fact that the leader of the doctors’ protest has only raised his fist in protest against health ministers from centre-right governments does not improve the image of the doctors either. The truth is that for all the life-saving work that doctors do, they deserve leaders much better than Marián Kollár .

After the Agriculture Ministry lifted its embargo, it turned out that the companies of Italians suspected of ties with ’Ndrangheta received subsidies worth millions of euros, through the Agricultural Paying Agency.